The modified Richmond Agitation-Sedation Scale (RASS) seems to be one of the best monitoring indicators for palliative sedation. We translated the modified RASS into Japanese according to the standard methods of conducting linguistic validation. The modified RASS revised two points from the original RASS for use in palliative care setting: deleted the description about the ventilator, and added some descriptions to clarify the meaning of RASS+1. In addition, we have deleted the description “rubbing sternum” in the procedure for RASS assessment, and then translated the modified RASS into Japanese. The translators and our research team members repeatedly discussed the linguistic validity until we agreed that the translated Japanese version is equivalent to the English one. The use of the Japanese version of the modified RASS to monitor palliative sedation may help to perform appropriate, and safe palliative sedation.

Abdominal paracentesis is a standard intervention for symptom relief in patients with ascites; however, there is no established agreement regarding the optimal speed of ascites drainage. This paper presents three cases of rapid manual drainage of ascites (RMDA) conducted during home visits: a 72 year-old male with intractable cirrhosis, a 73 year-old male with malignant ascites secondary to cancer of the pancreatic tail, and a 54 year-old male suffering from malignant ascites due to pancreatic tail cancer with hepatic metastases. Drainage volumes ranged from 1.4 to 3 liters, with procedures taking between 12 to 14 minutes. Post-procedure systolic blood pressures were maintained above 90 mmHg at immediate, 2 (±1) hours, and 24 (±12) hours following the procedure in all cases. No severe adverse events were reported. RMDA may offer a reduced procedural time in the home visit context, lessening patient discomfort and healthcare provider costs. Further studies are needed to evaluate the safety of RMDA in home care settings.